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To investigate the effect of timing of chemoprophylaxis on VTE and bleeding rates in patients undergoing major abdominal surgery.Postoperative bleeding and venous thromboembolisms (VTE) incur significant morbidity, mortality and healthcare costs. Chemoprophylaxis is used routinely to prevent VTEs but increases bleeding risk. The perioperative timing of chemoprophylaxis initiation may influence both VTE and bleeding risks. The optimal window for commencing chemoprophylaxis in the perioperative period is unclear.MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were searched using PRISMA guidelines. Randomized trials and cohort studies published between 01 January 2000 to 10 May 2022 which reported on chemoprophylaxis timing as well as the incidence of VTE and bleeding following elective abdominal surgery were meta-analyzed.From 6,175 studies, 14 (24,922 patients) were meta-analyzed. Bariatric (4 studies), antireflux (1 study), hepato-pancreatic-biliary (5 studies), colorectal (1 study), ventral hernia (1 study), and major intra-abdominal surgeries (2 studies) were included. Chemoprophylaxis was initiated before skin closure in 10,403 patients, and postoperatively in 14,519 patients. Both symptomatic (RR 0.81, 95% CI 0.45-1.43, P=0.460) and overall (RR 0.74, 95% CI 0.45-1.24, P=0.250) VTE rates were comparable between study groups. Compared with postoperative chemoprophylaxis, early usage increased the risk of all bleeding (RR 1.56, 95% CI 1.13-2.15, P=0.007), major bleeding (RR 1.63, 95% CI 1.16-2.28, P=0.005), blood transfusion (RR 1.48, 95% CI 1.24-1.76, P0.001) and reintervention (RR 1.94, 95% CI 1.19-3.18, P=0.008).Our findings advocate for initiating chemoprophylaxis postoperatively in elective abdominal surgery to minimize bleeding risk without compromising VTE protection.

Czech dysplasia, metatarsal type is an autosomal dominant skeletal disorder that is characterized by early-onset, progressive arthritis, brachydactyly of the 3rd and 4th toes, and characteristic radiographic findings in patients of normal stature. Patients with Czech dysplasia typically present in late childhood or later. In the present report, whole exome sequencing identified a mutation in COL2A1 (c.823C>T, p.R275C) known to be associated with Czech dysplasia in a 3.5 year old female who had a family history of early-onset arthritis and who was asymptomatic except for prominent knees. The use of whole exome sequencing facilitated diagnosis of this rare disease (less than 15 families in the literature) in the presymptomatic period and thus enabled us to provide early anticipatory guidance and genetic counseling for the family.